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Impaired lung function is a major clinical indicator of mortality risk in men and women for a wide range of diseases. The use of FEV1 as part of any health assessment of middle aged patients should be considered. Smokers with reduced FEV1 should form a priority group for targeted advice to stop smoking.

These preliminary results support the validity and reliability of the CARE measure as a tool for measuring patients' perceptions of relational empathy in the consultation.

PURPOSEThe inverse care law states that the availability of good medical care tends to vary inversely with the need for it in the population served, but there is little research on how the inverse care law actually operates.METHODS A questionnaire study was carried out on 3,044 National Health Service (NHS) patients attending 26 general practitioners (GPs); 16 in poor areas (most deprived) and 10 in affl uent areas (least deprived) in the west of Scotland. Data were collected on demographic and socioeconomic factors, health variables, and a range of factors relating to quality of care. RESULTSCompared with patients in least deprived areas, patients in the most deprived areas had a greater number of psychological problems, more longterm illness, more multimorbidity, and more chronic health problems. Access to care generally took longer, and satisfaction with access was signifi cantly lower in the most deprived areas. Patients in the most deprived areas had more problems to discuss (especially psychosocial), yet clinical encounter length was generally shorter. GP stress was higher and patient enablement was lower in encounters dealing with psychosocial problems in the most deprived areas. Variation in patient enablement between GPs was related to both GP empathy and severity of deprivation. CONCLUSIONSThe increased burden of ill health and multimorbidity in poor communities results in high demands on clinical encounters in primary care. Poorer access, less time, higher GP stress, and lower patient enablement are some of the ways that the inverse care law continues to operate within the NHS and confounds attempts to narrow health inequalities. 2007;5:503-510. DOI: 10.1370/afm.778. Ann Fam Med INTRODUCTIONS cotland has the lowest life expectancy for women in Western Europe and the second lowest for men, with a widening gap between the health of the rich and the poor.1 Twenty-one percent of the population in poorer areas have limiting long-term illnesses or disabilities, compared with only 8.5% in affl uent areas. 1 The bulk of health care in Scotland, as in the rest of the United Kingdom, is delivered through primary care, with fully trained family physicians-general practitioners (GPs)-practice nurses, and other allied health professionals accounting for almost 90% of the activity of the National Health Service (NHS). Clinical encounters are free at the point of use and accessible by 100% of the population. Since the inception of the NHS in 1948, however, the provision of primary care services has not been closely related to health needs in more socioeconomically deprived areas. The mismatch of need and supply has been termed the inverse care law, 2,3 which states that "the provision of good medical care tends to vary inversely with 504INV ER SE C A R E L AW the need for it in the population served." In Scotland, despite the steep gradient in need, the distribution of GPs remains fl at across socioeconomic indices. 4 Although inequalities in health and health care are well recognized, [5][6][7] there is a...

The QT interval, an electrocardiographic measure reflecting myocardial repolarization, is a heritable trait. QT prolongation is a risk factor for ventricular arrhythmias and sudden cardiac death (SCD) and could indicate the presence of the potentially lethal Mendelian Long QT Syndrome (LQTS). Using a genome-wide association and replication study in up to 100,000 individuals we identified 35 common variant QT interval loci, that collectively explain ∼8-10% of QT variation and highlight the importance of calcium regulation in myocardial repolarization. Rare variant analysis of 6 novel QT loci in 298 unrelated LQTS probands identified coding variants not found in controls but of uncertain causality and therefore requiring validation. Several newly identified loci encode for proteins that physically interact with other recognized repolarization proteins. Our integration of common variant association, expression and orthogonal protein-protein interaction screens provides new insights into cardiac electrophysiology and identifies novel candidate genes for ventricular arrhythmias, LQTS,and SCD.